'Mobile working' should be reality for community nurses, says DH report

Providing community nurses with laptops can significantly increase the number of patients seen and time spent with them, according to findings from a major national project.

The final report from the Department of Health’s national mobile worker project said it was “clear” that adopting mobile technology had the potential to significantly improve productivity and efficiency.

The 15-month project, which began in summer 2010, involved community staff at 11 pilot sites testing out Panasonic Toughbooks – it later focused on six sites.

The project sites were located in Bristol, east London, Yorkshire, Essex, Tees, Lancashire and parts of the Midlands, including Stoke, Birmingham and Northampton.

The report concluded that significant increases in productivity could be achieved by using the technology. This was demonstrated by “huge increases” in contacts between nurses and patients, which at one site in Hartlepool saw contacts by specialist nurses rocket by 142%.

Significant increases in time spent with patients were also seen following deployment of mobile devices, which in Tower Hamlets increased by 104%.

The report also noted that at some sites the number of journeys could be reduced up to 11%, time spent actually travelling by up to 33% and “no access” visits by up to 50%. A significant reduction in data duplication was seen at most sites.

The report said staff reported having much more confidence at the point of contact with the patient due to the greater amount of up-to-date clinical information they had access to – particularly on prescribing information and supporting resources such as the online BNF.

“Contrary to initial fears about the devices acting as ‘barriers’ between the clinician and patient, most users reported improved patient confidence and engagement when using the device,” the report said.

It added that the technology had proved “extremely popular” with clinical staff. However, it noted that training for all staff in the “basic functionality” of the devices was “essential”.

The report is intended to persuade directors of nursing and other senior managers to make “mobile working a reality for community staff”.

“In times of intense pressure to deliver good care outcomes within increasingly tight budgets, the potential savings that have been proven to be achievable by the introduction of mobile working cannot be ignored,” it stated.

Professor Viv Bennett, director of nursing at the Department of Health, highlighted the findings last week while giving evidence to the Commons’ health select committee about the state of nursing.

She told MPs how having mobile technology linked up to one electronic record system meant “the practice nurse in the surgery can look at the records and see the district nurse has been in the home, the district nurse can look up what the blood gases were that morning, give the appropriate care, provide the appropriate drugs, record the interaction immediately, it’s on one system; it’s safe.”

But she noted that use of mobile technology in community services was “extremely variable” at present, and that where it was absent it “breeds inefficiency as well as risking care”.

“People are driving 25 miles after they’ve written something down to enter it into a computer,” she said.

“Anecdotally, district nurses will tell me ‘it’s not acceptable I have less technology than a supermarket delivery driver’.”

“That resonates with me very strongly. It is not right, and we are going to do something about it, and have started to do so.”

In October last year prime minister David Cameron announced that the government would be making £100m available to spend on new technology for nurses and midwives.

The government said the money would be offered to the NHS in 2013-14 to promote the use of technology, such as digipens and other handheld mobile devices, to speed up access to patient and treatment information, while reducing time spent on form filling.

It will loan the technology funding to the NHS but trusts will only be required to repay a percentage. However, trusts and organisations that receive positive feedback from patients in the new “friends and family test” will not have to repay any of the loan.

Jeez we tried piloting mobile computers a couple of years ago and as mentioned above they couldn't get a signal half the time and by the time we had entered all the security passwords etc we could have seen ten more patients. Not that District Nursing works that way -we see whoever needs seeing - we just keep going until all are seen - no appointment times and no waiting lists.

What I am struggling to imagine is this 'blood gases' scenario - in so many ways this sounds like a fairy tale - not least in that who took the blood gases and how far did they drive to deliver them for analysis and what did the district nurse have about her person to administer without prescription?

Who would drive 25 miles to input data on a computer - we return to base after our visits - some of the more old fashioned even have lunch back at base. If not we still like to meet up and have to take back samples as well as see GP's and make referrals etc -its far quicker to log into the equipment site once back at base and order all you need instead of logging in at each patient. Its like the nurse prescribing thing [which is great] but its not true that the act of writing a prescription is sufficient to ensure you have supplies to hand - well if it is I haven't been given the magic pad type yet.

I actually do hope that we can use mobile computers instead of doing everything on paper and then on computer as we waste a lot of time in duplication however in my experience these pilots involve very specific groups of staff and if anything negative is said it is ignored and spun round to fit the goal of what was hoped for at the outset - hence a colleague of mine was quoted as saying how great mobile computers were and how much they had helped her when in fact she had merely grudgingly agreed in theory they could have helped and that was with her arm up her back.

We District Nurses are no different to any other nurse in that we could get a lot more done if it wasn't for managers finding us never ending forms to fill in and work to duplicate. Still we remain relieved that paper eventually took over from the more time consuming tablets of stone.

Hurrah!! At last..I argued 3 year ago this was the way forward for community nurses. Security? Would laptops be any less secure than the diaries we all heave around with patient data,or worse still scraps of paper with notes on patients which need to be completed on return to base. And the time it would save to be able to enter straight away the time we enter a home, and afterwards the time spent and leaving time. Its time community nurses were able to move into the 21st century and use the technology available.

Not really the point, but when I read 'mobile working' in connection with community nurses, my first reaction was 'Community Nurses are by definition mobile - they go from house to house - what the heck is this ?'.

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